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IMPLEMENTATION OF HEALTH
PROGRAMS IN THE DECENTRALIZATION
ERA AT BANGKA BELITUNG ISLANDS
PROVINCE
BY : drg. MULYONO SUSANTO, MHSM
Head of Health Department Bangka Belitung Islands Province
1.
INTRODUCTIONS
2.
NATIONAL AND REGIONAL HEALTH DEVELOPMENT
ACHIEVEMENT
3.
RESOURCES
ENDORSEMENT
DEVELOPMENT
4.
CHALLENGES
&
STRATEGIC
STEPS
ACCELERATE HEALTH DEVELOMENT
5.
BEST PRACTICES
6.
NATIONAL HEALTH INSURANCE
OF
HEALTH
TO
3
1. INTRODUCTIONS
 Geographic and
population
- Total Population
: 1.339.773
- Ecological
zones : Tropical
climate, and
archipelagic
geography
 The issue of decentralization in the post-reform Indonesia emerged around





1999 - 2000. It was signed with the enactment of Law No. 32 of 2004
Emergence of Law 32 0f 2004 on Regional Govermenthas brought a new
wind the Indonesian goverment from centralizedto the decentralized
With a decentralized model of Health, local government is given full
authority to regulate the sector of regional health systems.
In the process, the local government is highly dependent on several factors;
the financial support, cooperation, coordination across sectors, etc. in the
success of the health system in the region.
Bangka Belitung has officially ratified on 09 February 2001 when Indonesia
has entered the era of decentralization.
PP 38 of 2007 on the division of power between central and regional
government as well as covering the field of Health.
MINISTRY OF HEALTH
HOSPITAL
CENTER
DEPARTMENT OF HEALTH
PROVINCE
DEPARTMENT OF HEALTH
DISTRICT
PROVINCE
REGIONAL
HOSPITAL
DISTRIC
COMMUNITY HEALTH CENTER /
PKM
HEALTH VILLAGE POST (POSKESDES)/
SECOND COMMUNITY HEALTH CENTER
(PUSTU)
Cadre
2. NATIONAL AND PROVINCE
HEALTH DEVELOMENT
ACHIEVEMENT
STATUS
ACHIEVEMENTS
Numb
INDICATORS
TARGET
2014
Beginning
2009
2010
2011
2012
2013
2014
TRW I
70,9
71,1
71,1
n.A
n.A
1
Life expectancy (years)
70,7
72,0
2
The maternal mortality rate per
100,000 born alive
228
154,2 5) 149.8 5) 137,6 5) 119.7 5) 90.96 6)
118
3
The percentage of births attended by
skilled health personnel.
84,3
91.09 5) 94.46 5) 94.42 5) 91.62 5) 21.62 6)
90
4
The infant mortality rate per 1000
live births.
34
9.25 5)
8.4 5)
9.7 5)
7.69 5)
8.79 6)
24
5
Total Fertility Rate (TFR)
2,6
2,4 4)
n.A
2,63)
n.A
n.A
2,1
6
Percentage of population with
access to drinking water quality.
47,7
36.69 5) 83.36 5) 90.56 5) 80.87 5)
n.A
68
7
Percentage of population 15 years and
over who have knowledge of HIV and
AIDS.
66,2 1)
57,5 2)
n.A
79,5 3)
n.A
n.A
90
8
Annual Parasite Index (API)
1,85
4.82 5)
4.10 5)
2.36 5)
1.39 5)
0.17 6)
1
9
Percentage of population with health
insurance.
n.a
78.39 5) 79.53 5)
100 5)
93.74 5)
n.A
80,10
9
Ket : 1) SDKI, 2007; 2) Riskesdas, 2010; 3) SDKI, 2012; 4) Sensus Penduduk,2010; 5) Profil Kesehatan; 6) Program Terkait
STATUS
50
45
40
35
30
25
20
15
10
5
0
MDG’s 2015 : ≤
23/1000 KH
47
40
24
27
27
29
29
30
33
35
32
10
100
90
80
73.3
77.2
81.1
81.9
SUMUT
KEP. RIAU
85.6
87.1
90.9
93.3
93.9
94
85.2
70
60
50
40
30
20
10
0
RIAU
SUMBAR
ACEH
LAMPUNG BENGKULU
SUMSEL
JAMBI
Source : Ditjen P2PL, 2013
KEP. BABEL INDONESIA
11
Renstra’s Target :
75%
80
75.78
74.87
74.51
74.37
75.08
72.86
69.2
70
66.62
60.85
60.72
59.73
KEP. BABEL
RIAU
KEP. RIAU
60
50
40
30
20
10
0
SUMUT
LAMPUNG
SUMSEL
JAMBI
SUMBAR
BENGKULU
ACEH
INDONESIA
12
Source : Report of the Director General Nutrition, Ministry of Health,
6.00
5.32
5.00
4.00
3.00
2.47
MDG’s Target : 1/1000
of Population
2.00
2.66
1.69
1.29
0.84
1.00
0.10
0.20
0.20
0.25
LAMPUNG
RIAU
SUMSEL
SUMBAR
0.44
0.00
ACEH
SUMUT
JAMBI
KEP. RIAU
BABEL
BENGKULU INDONESIA
13
Source :Diit.PPBB –Ditjen PP dan PL, Ministry of Healt 2011
3. SUPPORT RESOURCES FOR HEALTH
DEVELOPMENT
14
DOCTOR RATIO PER 100,000 POPULATION
IN 2012
50
40/100.000 target of population
45
43,77
40
47,54
36,03
35,83
35
31,81
30
25,98
25
20
45,53
23,34
25,57 26,26
17,48
15
10
5
0
LAMPUNG KEP. BABEL
Source : Pusdatin
JAMBI
SUMSEL
BENGKULU KEP. RIAU
RIAU
ACEH
SUMBAR
SUMUT
INDONESIA
15
MIDWIFE RATIO PER 100,000 POPULATION IN 2013
Rasio Bidan :
100 / 100.000 penduduk
Souce : Pusdatin
16
CENTRAL GOVERMENT PROVIDES DOCTORS, DENTIST AND MIDWIVES
TO BE WORK IN REGENCY / MUNICIPALITY IN RURAL AREA
Nu
mb
DOCTOR
Dist/City
DENTIST
MIDWIVES
B
T
ST
JML
B
T
ST
JML
B
T
ST
JML
1
KAB.
BANGKA
-
4
-
4
-
-
-
-
8
5
-
13
2
KAB.
BELITUN
G
-
1
-
1
-
-
-
-
4
-
1
5
KAB.
BANGKA
BARAT
-
-
-
-
-
1
-
1
9
15
-
24
KAB.
BANGKA
TENGAH
-
-
-
-
-
-
-
-
9
-
-
9
KAB.
BANGKA
SELATAN
-
-
-
-
-
-
2
2
7
14
1
22
KAB.
BELITUN
G TIMUR
-
-
-
-
-
-
-
-
1
-
1
2
KOTA
PANGKAL
PINANG
-
-
-
-
-
-
-
-
14
-
-
14
17
3
4
5
6
7
Sumber : Data dan Informasi Prop. Kep. Babel
NO
SOURCE COST
TOTAL
1
DECONCENTRATION
2
9,006,000,000
5
Co-TASK / TP
BASIC SERVICES PUBLIC HEALTH
INSURANCE
PUBLIC HEALTH INSURANCE REFERRAL
SERVICE
LABOR INSURANCE (JAMPERSAL)
6
SALARY & INCENTIVES OF PTT
3,402,350,000
7
VACCINE AND DRUG PROGRAM
8,420,702,850
8
SPECIAL ALLOCATION FUND (PURE) / DAK
9
TPG KIT and Dacin
3
4
18,934,837,000
984,525,000
508,888,000
6,711,698,250
38,299,060,200
335,125,000
10 LOANS / GRANTS FOREIGN (PHLN)
11,324,748,072
TOTAL BUDGET HEALTH 97,927,934,372
97,927,934,372 / 163,916,444,689 out of total = 59.74259298 %
18
Revenue and
Expenditure Budget of
Local Government
(APBD)
PROVINCE
DISTRICT / CITY
TOTAL
TOTAL
51,878,637,393
112,037,807,296
163,916,444,689
19
K4
PN
National’s Target 2015: 95%
National’s Target 2015: 90%
JUMLAH (PROVINSI)
90.3
JUMLAH (PROVINSI)
PANGKALPINANG
91.1
PANGKALPINANG
BELITUNG TIMUR
BANGKA SELATAN
BANGKA TENGAH
BANGKA BARAT
BELITUNG
BANGKA
K4
Still below target
78.2
92.2
86.0
95.0
85.1
95.6
BELITUNG TIMUR
91.6
93.9
83.0
BANGKA SELATAN
91.4
BANGKA TENGAH
90.3
BANGKA BARAT
BELITUNG
91.5
88.6
BANGKA
PN
96.1
Upper target
21
90.00
76.48
80.00
70.00
66.82
80.77
62.02
66.80
64.46
Pangkal
Pinang
Propinsi
Bangka
Belitung
55.31
60.00
48.68
50.00
40.00
30.00
20.00
10.00
-
Bangka
Belitung
Bangka
Barat
Bangka
Tengah
Source : Data and Information of Babel Province2013
Bangka
Selatan
Belitung
Timur
22
KASUS HIV
159
KASUS AIDS
128
116
112
85
77
59
37
30
12
2009
2010
2011
2012
2013
23
MAP OF MALARIA IN BANGKA BELITUNG
PROVINCE
Malaria still an endemic disease in Bangka Belitung Province
100
90
95
Number of Cases of Malnutrition Bangka Belitung: 95 Cases
80
70
60
50
40
30
20
19
18
12
10
14
21
1
10
-
Bangka
Belitung
Bangka
Barat
Bangka
Tengah
Bangka
Selatan
Belitung Pangkal Propinsi
Timur
Pinang Bangka
Belitung
25
PROBLEMS
STRATEGIC STEPS
Disparities in access to
maternal and child health
services (facilities,
personnel, health
services limited
warranty).
1.
2.
•
•
•
•
•
Strengthening health services in regions A, B, C
Improving access and quality of health services :
Community health centers PONED
Hospital PONEK
Assurance processes of birth (Jampersal),
BOK
Linakes Skilled
Preventive and promotive
efforts really not optimal
Increased promotive-preventive:
• Program Planning & Childbirth Complications
Prevention: ANC - KB & exclusive breastfeeding
• Mothers movement - exclusive breastfeeding PP
33/2012
• Integrated health posts (posyandu) and sub-village
active standby
• Fully immunized
management of health
services is too weak
Improved management of health services:
• The integrated system of vital registration,
• Accreditation & referral network optimization.
• System of maternal and child health services (KIA)
which meet the criteria continum of care.
26
Problems
Strategic Steps
1. New infections
continue to rise, more
extensive
transmission area.
• Prevention Efforts (condoms, IHS,
PDB, PPIA), early diagnosis (PITC)
and early treatment (CD4 350)
should be increased.
2. Promotive-preventive
GTT HIV and AIDS at
the age of 15-24
years.
• Increased knowledge pd age 15
years upwards on HIV and AIDS.
• Campaign, “I Know I'm Proud”.
3. The percentage of
people living with HIV
who received
antiretroviral
The increase in the percentage of
people living with HIV who get
antiretroviral treatment to 50
percent.
27
KONDOM
EDUCATION
• MORAL
• RELIGION
• REPRODU
CTIVE
HEALTH
• DANGER
OF NAPZA
PREVENTION
• Prevention of Sexual
Transmission
Through (PMTS)
• Bad effects of drug
prevention (PDBN)
• Prevention of
transmission through
the Maternal and
Child ( PPIA)
LKB
P
KPA
Health-care
facilities
communites
“PERKUAT JEJARING INTERNAL”
“PERKUAT JEJARING
EKSTERNAL”
LASS
TES
HIV
IPWL
TREATMENT
•Expansion Testing
• STI patients
• injecting drug
users
• HIV + Pregnant
Women
• serodiscordant
couples
• TB Coinfection
• Patients with
Hepatities B & C
•Early initiation of
antiretroviral drugs on
28
key populations,
5. BEST PRACTICE
29
ADULT
ELDERLY
TEEN
TEEN
SMS GATEWAY
CHILD
CLASS MOM
Gymnastics
PREGNANT
BABY
P4K
Integrated Service
Post :
Neonatus visits
early
childhood
education
(PAUD)
immunization Basics
BKB
Integrated
Management of
Childhood Health
KB
School Health
Unit (UKS)
PKPR
Clean and
Healthy
Behavior
HOME VISITE BY
MIDWIFES TO
PREGNANT WOMEN
TWICE IN A MONTH
PARTNERSHIP
MIDWIFE and
shaman
•Service Post
(posyandu )
-Elderly
•PTM
J
K
N
BEST PRACTICES
Alert Village
Primary Health
Care
•
•
•
•
•
Maternal health services
Health Services nursing mothers
For child health services
Family planning services
The discovery and disease management
Community
Empowerment
• Developing Enterprises Bersum Kes-powered mobi
(IHC, Clinics, Drug Pos Village, health fund, Standby
husband, etc.)
Encouraging surveillance (observation / monitoring,
Quick Reporting, Prevention & mitigation, Mortality
Reporting)
Clean and
Healthy Behavior
• Knowledge and awareness, community
awareness and preparedness, nutritionconscious families and health behavior,
environmental health, self-sufficient community
capacity in health
1. MTBS Stand for Integrated Management of Childhood Illness or Integrated
Management of Childhood Illness (IMCI in English) is an integrated approach /
integrated in the management of sick children with a focus on the health of children
aged 0-5 years (toddlers) thoroughly.
2. UKS abbreviated school health is an effort made to help school pupils and the
school community who are sick in the school environment. UKS is usually done in
a school nurse's office.
3. Adolescent Health Care Services (PKPR) is a Youth Care Health Services, serving
all of the youth in the form of counseling and various things related to adolescent
health. Here teenagers do not need to hesitate and worry for vent / counseling,
getting the right information and the right to a variety of things to know teenagers.
4. ANTE Natal Care (ANC) health examination given to pregnant women on a regular
.basis that is four times during pregnancy.
5. CLASS OF PREGNANT WOMEN (Kelas Ibu Hamil) Pregnancy Class is a study
group of pregnant mothers with gestational age between 20 weeks s / d 32 weeks
with a maximum number of 10 participants. In this class of expectant mothers will
learn together, discuss and exchange experiences on Maternal and Child Health
thorough and systematic and can be done on a scheduled basis and continuously.
6. Integrated Service Post is a neighborhood health center providing primary
health services, integrated with early childhood activities, BKB and SDIDTK.
7. Early childhood education (PAUD/ECD) is the level of education before primary
education which is an effort aimed at the development of children from birth to
the age of six, which is done through the provision of educational stimulation to
assist the growth and development of the child's physical and spiritual so has the
readiness to enter further education, which was held in formal, non-formal, and
informal.
8. Detection of Early Intervention Stimulation of Growth (SDIDTK) is to make an
effort monitoring the growth and development of children.
9. PHBS is a set of behaviors that is practiced on the basis of consciousness as a
result
. of learning that makes a person or family can help themselves in the field of
health and play an active role in creating public health.
6.NATIONAL HEALTH INSURANCE
34
The National Health Insurance (JKN) is part of the
National Social Security System (Navigation) held by the
Social Security Agency (BPJS) using the mechanism of
social health insurance which is compulsory
(mandatory) based on Law Number 40 Year 2004 on
National Social Security System with the aim of to meet
the basic needs of a decent public health given to every
person who has paid dues or dues paid by the
Government.
BASIC OPERATION LAW OF JKN
 1945 Article 28 H paragraph (1), (2), (3)
 1945 Article 34 paragraph (1), (2)
 Law No. 40 of 2004 on National Social Security
System (Navigation).
 Act No. 24 of 2011 of the Social Security Agency
(BPJS)
 Regulation No 101/2012 on the Recipient
Contribution (PBI)
 Presidential Decree No. 12/2013 on Health
Insurance
 Regulations and other provisions there are 14
product regulation
MEMBERSHIP
Contribution
OBLIGATIO
N
JAMINAN
KESEHATAN
NASIONAL
lABOUR
LABOURRER
NON
LABOUR
INDIVIDUAL
POVERTY/
POOR
GOVERMENT
37
AMOUNT OF
CONTRIBUTION
FACILITIES
CARE CLASS LEVEL 3
CARE CLASS LEVEL 2
CARE CLASS LEVEL 1
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